Improved Progression-Free Survival for Bulky and Non-Bulky Advanced Stage Diffuse Large B-Cell Lymphoma With Consolidative Radiation Therapy: A Bi-Institutional Analysis.

• Type of Material: Article
• Authors: Yusef A. Syed, Emory University; Cecilia Jiang, University of Pennsylvania; Jeffrey M. Switchenko, Emory University; Khadija Kirmani, Lipscomb University; Christopher Kelsey, Duke University; Mohammad Khan, Emory University
• Language: English
• Date: 2021-08
• Publisher: Cureus
• Publication Version: Final Published Version
• Copyright Statement: © 2021, Syed et al.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.7759/cureus.17107
• Title of Journal or Parent Work: Cureus
• Volume: 13
• Issue: 8
• Start Page: e17107
• End Page: e17107
• Grant/Funding Information: Jeffrey Switchenko declare(s) a grant from National Institutes of Health. NIH P30, Award #: P30CA138292. Chris Kelsey declare(s) a grant from National Institutes of Health. NIH sponsored studies 5R01-CA201212-04, 5R01-HL105643-08. Chris Kelsey declare(s) Payment for expert testimony from Johnson and Johnson. Chris Kelsey declare(s) Payment for expert testimony from Colgate Palmolive.; Research reported in this publication was supported in part by the Biostatistics Shared Resource of Winship Cancer Institute of Emory University and NIH/NCI under award number P30CA138292. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
• Keywords: adjuvant; non-hodgkin’s; radiation therapy; r-chop; rituximab; imrt; involved site
• Research Categories: Health Sciences, Rehabilitation and Therapy; Health Sciences, Oncology; Biology, Radiation

Abstract

Background The role of consolidative radiation therapy (RT) for advanced-stage diffuse large B-cell lymphoma (DLBCL) is not fully established. A growing body of data suggests a role for consolidative RT in select stage III-IV DLBCL patients and emerging data from randomized studies further address the role of RT in advanced-stage patients initially presenting with bulky disease. Methods Patients with treatment-naive stage III-IV DLBCL treated at two institutions who achieved a clinically complete response to systemic therapy were included. Patients with either bulky or non-bulky disease were included, but those with the relapsed or refractory disease were excluded. Kaplan-Meier analysis was performed to determine the impact of consolidative RT. Univariate and multivariable analyses were performed using a Cox proportional hazards model. Results One hundred eighty-eight patients received systemic therapy consisting of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP; 79%), another rituximab-based regimen (9%), or chemotherapy alone (12%). Clinical response was assessed using conventional CT or PET-CT. Sixty-eight patients (36%) received consolidative RT (median dose 30 Gy). Consolidative RT conferred a 36.7% absolute benefit in five-year progression-free survival (PFS; 85.9% vs. 49.2%, log rank p < 0.0001), a 14.5% absolute benefit in five-year overall survival (OS; 87.4% vs. 72.9%, log rank p = 0.0134), and a 37.0% absolute benefit in five-year LC (91.9% vs. 54.9%, log rank p < 0.0001). On multivariable analysis, consolidative RT was associated with improved PFS (HR 0.23, 95% CI 0.10-0.52, p < 0.001) and LC (HR 0.20, 95% CI 0.07-0.59, p = 0.003). Patients receiving consolidative RT demonstrated significantly improved PFS for tumors measuring both <5 cm (log rank p = 0.0454) and ≥5 cm (log rank p = 0.0003). Conclusions For patients with stage III-IV DLBCL who achieve clinical complete response after systemic therapy, consolidative RT improves PFS for all patients, including those with the non-bulky disease. This benefit persists in the setting of rituximab-based systemic therapy.